Individual
MR. CHRISTOPHER M WIEDERHOLD
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CRNA
Contact information
Practice address
2142 N COVE BLVD, TOLEDO, OH 43606-3895
(419) 471-4491
(419) 479-6905
Mailing address
2914 S REPUBLIC BLVD, TOLEDO, OH 43615-1912
(419) 531-8808
(419) 531-9342
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
263271
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
104377548
MICHIGAN MEDICAID
MI
05
—
2298697
—
OH
01
—
430067803
RAILROAD MEDICARE
OH
Enumeration date
07/13/2005
Last updated
11/03/2023
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